Reimbursement Specialist

4 weeks ago

Knoxville, Tennessee, United States McNabb Center Full time
Job Summary

The Reimbursement Specialist is responsible for obtaining and verifying a client's commercial insurance coverage and ensuring that procedures are covered by an individual's insurance. This role involves entering data in an accurate manner and updating client benefit information in the organization's billing system, as well as verifying existing information for accuracy.

Key Responsibilities
  • Analyze designated eligibility reports on a daily basis to ensure accurate and timely processing of insurance claims.
  • Communicate with and advise the Insurance Verification Team Leader on any questions or problems related to insurance verification.
  • Adhere to all policies and procedures related to compliance with federal and state billing regulations.
  • Communicate with billing representatives regarding any insurance issues that may arise.
  • Maintain a positive and professional attitude, with a focus on providing excellent customer service.
  • Read and respond to all emails and voicemails in a timely manner.
  • Work with members of various teams and/or departments to identify process improvements and implement changes as needed.
  • Possess flexibility to work overtime as dictated by department/organization needs.
  • Assist in determining proper courses of action for resolution to insurance issues.
  • Possess problem-solving skills to research and resolve discrepancies, denials, appeals, and collections.
  • Possess strong analytical and critical thinking skills to identify and resolve complex insurance issues.
Requirements
  • Advanced use of computer systems, software, Excel, Outlook, and Microsoft (word processing and spreadsheet application).
  • Knowledge of Centricity is a strong plus.
  • Knowledge of insurance guidelines, including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care's, Medicaid, and Private Pay.
  • Ability to work well in a team environment and alone, with strong communication and interpersonal skills.
  • Strong written and verbal communication skills, with the ability to communicate effectively with internal and external stakeholders.
  • Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
  • Knowledge of the center's Policies and Procedures.
  • Ability to maintain records and prepare reports and correspondence related to the position.
  • Ability to work directly with upper leadership regarding claims issues and resolutions.
  • Possesses effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others.
Work Environment
  • Work in a fast-paced, dynamic environment with a focus on providing excellent customer service.
  • Collaborate with a team of professionals to achieve common goals and objectives.
  • Work in a professional office setting with a focus on maintaining a positive and respectful work environment.
Compensation and Benefits
  • Starting salary for this position is approximately $18.42/hour based on relevant experience and education.
Location
  • Knoxville, Tennessee

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